Healthcare Provider Details

I. General information

NPI: 1003989344
Provider Name (Legal Business Name): YEHUDA SHAPIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIJMC - DEPT OF PEDIATRIC CARDIOLOGY 269-01 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

LIJMC - DEPT OF PEDIATRIC CARDIOLOGY 269-01 76TH AVENUE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7350
  • Fax:
Mailing address:
  • Phone: 718-470-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number168554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: